The Association between Affect and Biomarkers of Stress and Inflammation in Healthy Seventh-Day Adventists.

OBJECTIVE: To evaluate the association between positive and negative affective states with stress biomarkers, biomarkers of inflammation and blood pressure in a population of healthy Seventh-day Adventists. DESIGN: In a cross-sectional study, biomarkers were regressed on positive and negative affect and control variables among reportedly healthy 133 females and 100 males (35% Black and 65% White) who provided blood and urine samples following completion of a questionnaire and measurement of anthropometrics and vital signs. SETTING/LOCATION: Data were extracted from the Biological Manifestations of Religion Study, an NIA-funded study conducted in members of the entity who lived within driving distance of two clinic sites. OUTCOME MEASURES: The stress biomarkers, epinephrine, and norepinephrine, were measured in 12-hour overnight urine samples analyzed by high-performance liquid chromatography. Urinary cortisol was evaluated by enzyme-linked immunosorbent assay (ELISA) and normalized for urinary output (reported in µg/g creatinine). Serum DHEA-S (reported in µg/ml) was measured by ELISA. Inflammatory markers included CRP (ng/ml), IL-6, IL-10, and TNF-α, all analyzed in serum by ELISA, and the data expressed in pg/ml. RESULTS: Multiple linear regression analyses showed after controlling for age, gender, ethnicity, body mass index (BMI), education, socioeconomic status, exercise, and use of blood pressure medication, that negative affect was associated with higher levels of epinephrine (ß = .143; P = .030). Positive affect was not associated with the biomarkers. CONCLUSIONS: While negative affect was associated with a biomarker of sympathetic stimulation, positive affect was not protective against such stimulation.

The Effect of a Tobacco Dependence Treatment Program With Stress Management Through Mindfulness Technique Training in US Veterans.

OBJECTIVE: The purpose of this study was to examine whether the Life-Change Stop Smoking Program (tobacco dependence treatment program with Stress Management/Mindfulness Training) was more effective in achieving 6 mo of smoking abstinence among a high-risk group, such as US veterans at the Loma Linda Veterans Affairs (VA) Medical Center, compared with the VA's conventional stop smoking program. The effects of participants' initial stress level and depression risk on achieving abstinence were also assessed. METHODS: Through examination of medical records and confirmation of exhaled air carbon monoxide level, abstinence status from smoking was determined at the 6-mo follow-up of the Life-Change Stop Smoking program (study group) participants and the Break the Chains program (comparison group, age and gender matched) participants. The 6-mo abstinence rates of the study group and comparison group were analzyed. RESULTS: The statistically significant level of difference (χ2 [P < .001], regression [P = .0000]) in 6-mo abstinence rates between groups was observed. CONCLUSION: The stop smoking program with Stress Management/Mindfulness Training was effective (64.6% in study group, 40.1% in comparison group, P < .001) in achieving 6 mo of smoking abstinence for the high-risk group.

Determinants of vitamin D levels in men receiving androgen deprivation therapy for prostate cancer.

PURPOSE: Studies found an association between decreased 25-OH vitamin D blood level and prostate cancer progression. Vitamin D supplementation is controversial and dosage recommendations inconsistent. This study identified factors associated with 25-OH vitamin D levels and whether vitamin D supplementation with 800 IU/day raised vitamin D levels in prostate cancer patients receiving androgen deprivation therapy (ADT). DATA SOURCES: We recruited 108 men treated with ADT for ≥9 months from eight cancer and urology practices. Sections of the NHANES 2005-2006 questionnaire and Canadian Fitness Survey were completed identifying age, ethnicity, length of ADT use, calcium supplementation ≥1000 IU mg/day, body mass index, exercise, alcohol and tobacco use, and vitamin D supplementation ≥800 IU/daily. Blood was collected for 25-OH vitamin D analysis. CONCLUSIONS: The majority of men (66%) had blood levels of 25-OH vitamin D <32 ng/mL. Regression analysis showed vitamin D supplementation (ß = 6.556, CI 1.463, 11.650; p = .012) and African American ethnicity (ß = -7.816, CI -12.996, -2.635; p = .003) is associated with 25-OH vitamin D level after controlling age and tobacco use. PRACTICE IMPLICATIONS: Findings support current recommendations for supplementation with ≥800 IU vitamin D/day for men receiving ADT. Nurse practitioners caring for prostate cancer patients receiving ADT should include vitamin D monitoring and supplementation.

Self-reported exercise and bone mineral density in prostate cancer patients receiving androgen deprivation therapy.

PURPOSE: Men with prostate cancer receiving androgen deprivation therapy (ADT) are at increased risk for decreased bone mineral density (BMD). This study evaluates the relationship between self-reported daily activity, endurance and resistance exercise, and BMD measured by dual-energy x-ray absorptiometry (DEXA) in prostate cancer patients receiving ADT. DATA SOURCES: We recruited 96 men treated with ADT for ≥9 months from urology and cancer practices. The Canadian Fitness Survey assessed daily activity and exercise. Data on demographic and lifestyle characteristics and calcium and vitamin D supplementation were collected. Blood was collected for analysis of 25-OH vitamin D. A DEXA scan was performed. CONCLUSIONS: A positive association between endurance exercise and DEXA T-scores of the hip was shown. Regression analysis showed endurance exercise of medium to heavy intensity (measured as energy expenditure in MET-hours/week) was associated with T-scores of the hip (ß = 0.048; 95% CI 0.003, 0.112; p = .040) but not with spinal T-scores after controlling for age, body mass index, and alcohol use. IMPLICATIONS FOR PRACTICE: Findings are cross-sectional, but if confirmed in prospective studies suggest that increased endurance exercise is a practical measure nurse practitioners can institute to prevent low bone density in the hip of men treated with ADT.

The effects of simultaneous exercise and psychotherapy on depressive symptoms in inpatient, psychiatric older adults.

CONTEXT: Depression is the leading cause of early death, affecting 15% of Americans older than 65 y and costing $43 billion each year. The current mental health service system for seniors, particularly for the population hospitalized in acute inpatient psychiatric units, is fragmented because of poor funding and a shift to a transitory health care paradigm, leading to inadequate treatment modalities, questionable quality of care, and lack of research demonstrating the superiority of a particular treatment. These issues are likely to lead to a public health crisis in the coming years. OBJECTIVE: To investigate the effectiveness of combining exercise and psychotherapy in improving acute depressive symptoms among older adults who were receiving treatment in an inpatient psychiatric unit. DESIGN: Based on rolling admissions, inpatients were randomly assigned to 1 of 3 treatment groups. The study was blinded and controlled. SETTING: This study took place in inpatient psychiatric units at the Loma Linda University's Behavioral Medicine Center (LLUBMC) in Redlands, California. PARTICIPANTS: Participants were 78 inpatients, aged 50-89 y. INTERVENTION: Participants in the simultaneous exercise and psychotherapy (STEP) group (n = 26) took part in exercise and received psychotherapy for 30 min per session, whereas those in the TALK group (n = 26) received individual psychotherapy for 30 min per session. Participants in the control group (n = 26) served as a comparison group, receiving standard therapy. OUTCOME MEASURES: The effects of the interventions were determined by assessing differences from baseline to postintervention in the symptomatology of all 3 groups. The research team also administered the Behavioral and Symptom Identification Scale (BASIS-32) and the Geriatric Depression Scale (GDS) pre- and postintervention. RESULTS: At posttest, the STEP group (M = 4.24, SE = 0.62) had a better response than the TALK group (M = 11.34, SE = 0.62, P < .001), which in turn showed greater improvement than the control group (M = 14.84, SE = 0.62, P < .001). Overall, these results indicate that patients' posttreatment depression scores were significantly lower in those receiving the STEP treatment compared with those receiving individual psychotherapy only or standard care. CONCLUSION: A short-term exercise program consisting of 30 min of walking in conjunction with individual psychotherapy was an effective intervention for depression among older adults in inpatient psychiatric units.